Requests for Religious Concordance: Recognizing the Particular while Preserving the ProfessionalJacob Blythe, MD(c), MA, Stanford University School of Medicine, and Farr Curlin, MD, Duke University, Josiah C. Trent Professor of Medical Humanities, an d Co-Director of the Theology, Medicine, and Culture Initiative

How should individual physicians or institutions respond when patients request patient-physician concordance with respect to religious background or affiliation? This question represents one instance of a wider set of challenging cases encountered by physicians: namely, cases in which patient-physician concordance along some demographic dimension is requested by a patient. Requests for concordance exert pressure on the presumptive bifurcation of the personal and the professional aspects of individual physicians. The relevant normative question elicited by this pressure concerns how aggressively we should attempt to preserve the artificially-maintained separation between personal and professional aspects of physicians.

While we hold that a degree of separation is necessary and should be preserved, we also believe that prevailing ethical narratives that argue for stripping physicians of their concrete, particular characteristics when they don their professional role are grounded in three false premises: (1) a false construal of medical practice as a purely bureaucratic and technological venture; (2) false claims about what many physicians and many patients want from contemporary medical practitioners; and (3) a false characterization of the medical practitioner as an interchangeable and “anonymous functionary,” as opposed to a concrete individual with particular characteristics who has acquired professional expertise and has submitted to certain professional commitments. These three false premises undergird normative arguments for the rigid separation of professional and personal aspects of physicians—arguments that entail a resistance to requests for patient-physician concordance.

By showing these premises to be false, we hope to clear space for acknowledging that every physician, and every patient, arrives at a clinical encounter deeply rooted in specific traditions of thought and practice. Moreover, we hope to highlight that these traditions impact the achievement of medical goods that are responsive to patients’ values and preferences. By pretending that this is not the case, we foreclose the possibility of considering concordance or discordance as relevant to achieving certain medical goods.

Discovering a patient’s values and preferences is a skill that involves attending to the particularities of her past and present as well as the various possibilities for her future, and sometimes, the exercise of this skill may be enhanced by concordance. Concordance may supply a “common idiom” for the recognition of inconspicuous aspects of patients that are salient to medical decision-making. The influence of concordance may only impact the achievement of medical goods in a minority of cases, but we believe that considering this impact is a necessary component of practicing medicine in the most robust and responsive fashion. To eliminate the possibility of this consideration by submitting to arguments grounded in the false premises mentioned above is to err. We believe that it is more honest to admit that physicians represent the profession but also always bring idiosyncratic attributes to patient care. Practicing medicine well requires attending to both aspects of this singular identity, which entails bringing to bear both what medicine offers and what this particular physician offers (which may be a religious affiliation) for the healing of a patient.